Meta Analysis Clamping

Defining premature birth is much more than just a denotative phrase. It is not just a preterm birth, or a baby born early. It is a life-changing event, and something that affects millions of people worldwide. The intense quiet room with heart monitors beeping, as parents see their baby and are devastated. Loved ones can not feed them or kiss them nor, can they not hold them or hug them. They do not get the same experience as others. Little miracles lay inside these cubes where multiple wires are help keeping them alive. A place where prayers happen, and where all hope for the best. Nobody knows the true pain and struggle behind a preterm birth and it needs to be discussed. Prematurity is a serious conflict; therefore, it needs more awareness as many families are facing this tough situation.

The purpose of a systematic review is to attempt to find, evaluate and synthesize high quality research relevant to the research question. A systematic review uses carefully developed data collection and sampling procedures that are put in place in advance as a protocol. (Polit, 2012). A systematic review must contain the following: a clear inclusion and exclusion criteria, an explicit search strategy, systematic coding and analysis of included studies, and a meta-analysis if possible. (Hemingway & Brereton, 2009). Systematic reviews are conducted by nurse researchers to avoid reaching incorrect or misleading conclusions that

It is easy to see that the medical abilities and tools we had 50 years ago are nothing in comparison to what we have today. Among these advances has been the extent to which we can prevent illness and disability. Fetal surgery first emerged in the 1980’s by Dr Michael Harrison aka “the father of fetal surgery,” when he decided to look into ways doctors could fix certain defects before birth to avoid their inevitable, devastating consequences. It has since expanded its practice to a number of hospitals across the country, although it is still an uncommon procedure. It involves opening up the mother 's uterus (just as a doctor would during a caesarean section) so that the fetus is exposed as much as needed to be operated on. The fetus is then put back and the uterus is closed until it is time for the mother to go into labor. The fetus is never detached from the mother and is essentially being operated on while inside the womb (Smajdor). While it may seem like a positive life changing procedure, there are many perspectives out there that support

Evidence based practice is the incorporation of individual clinical expertise with best research evidence and patient values and expectations. Health care decision of individual patients should be based on best available research evidence. A health decision made from a sound research evidence has the potential to ensure best practice and reduce variations in health care delivery. In health science, an ever increasing plethora of studies being published and is challenging for clinicians to keep up with the literature. Integrating research into practice is time consuming and need methods for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on the latest research evidence. Systematic reviews and meta-analyses summarize the research evidence, which is generally the best form of evidence, thereby making the available evidence more accessible to decision makers and are positioned

Randomization was used to generate what patient went to which group. The way the patients were chosen eliminated bias because “Randomization was performed according to a computer-generated list by means of sequentially numbered, opaque, sealed envelopes which revealed the allocation of the subject to either induction or expectant management”(Nielsen et al. p. 60). This secure randomization added a great strength to the study. The sample size seemed fairly large, 226 patients were split into 116 for elective induction and 110 to expectant management, although the power analysis was disclosed in this study and determined that 600 patients were required. Only 226 patients were used and because it would take 4 years to reach the required amount of patients, the study was discontinued. This was both a strength and weakness because disclosing this information made the study more honest but the quota needed to reach the best answers was not attained. The study for the 226 patients was pretty standard with the 80% power and alpha at 0.05. T-test and chi square tests were used to compare the proportions between the groups of people. The women were chosen based on the inclusion criteria of being 39 weeks gestation or older, maternal age of more than 17, fetal cephalic presentation, singleton gestation, a candidate for vaginal delivery, and a Bishop score of 5 or greater in nulliparous women and 4 or greater for multiparous women. This inclusion criterion was a concern because both nulliparous women and multiparous women were being tested together. This was a weakness because the labor patterns of a nulliparous woman compared to a multiparous woman are very variable and sure to distort study data. It was also disclosed how gestational age was achieved which included the crown rump test measured in 6-12

The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies.

Why would delayed cord clamping even be a topic of discussion or in practice if it was not beneficial to some degree for the neonate or mother? Early cord clamping takes place almost immediately after delivery and delayed cord clamping is preformed anywhere for 30-180 seconds after birth. The validity of the above question has been on the rise for some time. Why some doctors have made it protocol during a delivery or simply do it only if requested is still not yet understood. Some would say there are little benefits to waiting to clamp the umbilical cord after delivery, and some say there are many benefits, and then there are those that say there is no difference whether you clamp early or delayed. Throughout my research I have learned that yet some physicians will not wait to clamp the umbilical cord, there are minimal risk, if any, and although at first I thought delayed clamping was without a doubt more beneficial than immediate clamping, they really are not profound in the grand scheme of the neonates’ health. However, I have learned that in the preterm neonate waiting to clamp the umbilical cord can be more beneficial for various reasons than in a full term neonate. Because of the medical background I have, I believe the benefits for both mother and child are important postpartum, however, those that choose to not participate in delayed clamping are not putting their newborn at any risk

According to the World Health Organisation [WHO] (2014) pre-term babies are at increased risk of illness, disability and death. It also states that globally 15 million babies are born pre-term and the figures are rising. In England and Wales during 2012 7.3% of live births were pre-term under 37 weeks nearly 85% of all babies born prematurely will have a very low birth weight (Office for National Statistics, 2012). Pre-term birth is associated with respiratory complications and lung disease, long-tern neurological damage and problems with bowel function (Henderson & Macdonald, 2011). Neonatal services provide care to babies who are born prematurely or are ill and require specialist care. It is seen that sixty per cent of infant deaths occur in the neonatal period (DH,

Ricci, S. Kyle, T. and Carman, S. (2017). Maternity and pediatric nursing 3rd ed. Philadelphia:

After revising the key terms, additional searches were made using both CINAHL and MEDLINE databases, with each article being evaluated and better search mechanisms being applied. In this search the key words preterm AND aboriginal women were used with the result being relatively successful, however there were still a number of articles that were not all applicable. I then decided to go through each article and critique how each study was conducted and what information it could provide to increase my knowledge on the factors that affect preterm birth. Additionally I also looked at which articles provided the highest level of evidence using NHMRC guidelines, as well as observing the number of people who had cited the source (National Health and Medical Research Council, 2015). Being more specific in database searches was a skill that became vital in the search process (Symmons, 2013). For example, I also chose synonyms such as, ‘neonatal outcomes’ and ‘premature pregnancy’ so articles relevant to preterm birth could be discovered. By establishing effective search terms, evaluating the reliability of the source, restricting

I also performed a search on the Cochrane library. The Cochrane library is a collection of six databases that contain systematic reviews for health and social care (Aveyard 2014). It is argued that the literature available at the Cochrane library is the ‘gold standard’ of research. Unfortunately, the search within the Cochrane library only produced one piece of research which had to be excluded as it as related to paediatrics and did not fit the criteria for the search and could not be included for this dissertation.

Cesarean section (C/S) births can occur in the hospital for several reasons. Some women choose to have elective C/S birth and others require C/S births out of infant or maternal safety, complications, or by necessity. This paper discusses both elective and emergency C/S deliveries and reviews both National Guideline policy and Carilion Clinic policies on C/S births. The problem statement is: in pregnant women (population), does C/S delivery following National or Carilion policies (IV: exposure vs. none-exposure) differ in terms of patient care and outcomes concerning maternal and neonatal health (DV)?

The method used was double blind randomized control study, the neonates were placed into either the experimental or control group by computer. The study was conducted by registered nurses who all had at least two years of experience in the NICU as a staff nurse. The nurse obtaining the study data remained blind to whether the patient received the intervention of sucrose or not, by stepping out of the room while the patients primary nurse opened up an envelope containing information if the patient was to receive 0.5mL of sucrose or not. The primary nurse would then administer the sucrose if indicated prior to the nurse collecting data for the study would return. The sucrose was administered between one and three minutes prior to the arterial puncture procedure. Every neonate was swaddled for the procedure and a pacifier was held in place lightly while the arterial puncture was performed. The nurse investigator would obtain the NIPS score, heart rate, and oxygen saturation, after the needle was inserted and then one minute after completion of the procedure. Milazzo, et al. (2011), found that the average gestation of the neonate in this study was 33.8 weeks and there was no difference in age of gestation for the experimental or control groups. The NIPS score was found to be between zero and three

An argument for the case of minimal medicalized intervention during birth can be made in terms of low-risk pregnancies and reserving medical interventions for high-risk deliveries and emergency situations. The purpose of this paper is to ensure that members of the childbearing community, including healthcare professionals, are familiar with alternative interventions to cesarean section and thoroughly consider the risks and benefits of said interventions so that natural child-birthing methods can be promoted in low-risk situations.

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.